AccountId: 011433970860
ContactId: d1da6a63-6714-4b40-a946-01c4963f49aa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 571109 ms
Total Talk Time (AGENT): 299499 ms
Total Talk Time (CUSTOMER): 256999 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/d1da6a63-6714-4b40-a946-01c4963f49aa_20250205T20:27_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi um my name's [PII]. I just uh spoke with somebody, um, a few minutes ago and it was about my plan and a couple of claims that I, um, I actually just uploaded them into my account and I was just calling to verify that they actually did get uploaded and I think I may have done it twice.
[AGENT][POSITIVE] Oh OK, no worries. I can take a look at that for you. Do you have your policy number handy?
[CUSTOMER][NEUTRAL] Uh, yeah, is that the outpatient number?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, it's 02235729 ML 8.
[AGENT][NEUTRAL] Thank you so much and I know you just went through this, but I'm gonna have to verify all the information with you again if you could verify your last name and your date of birth, Miss [PII].
[CUSTOMER][NEUTRAL] Uh, sure, it's [PII] and date of birth is [PII].
[AGENT][POSITIVE] Perfect. And then that mailing address on file, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect and then lastly it's just that phone number and email on file if you could verify that for me.
[CUSTOMER][NEUTRAL] [PII] and email is [PII].
[AGENT][POSITIVE] Perfect thank you so much is that a good number to give you a call back on if we were to get disconnected today, ma'am?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Perfect and Miss [PII], I do see that we received your upload. I do see that we've received two of them, um, but I will put a note in that they can disregard one of them and that they only need one to process.
[CUSTOMER][NEUTRAL] OK, and it was a bunch of different files, right? I think there were maybe like 8 or 9.
[AGENT][NEUTRAL] So I actually can't open them up yet, but I can tell you that they're in Q2 be processed until an examiner goes through them we're not able to go through them, um, but, um, they are, they are, I cannot talk. I'm so sorry um they're in Q2 be processed, um, and that examiner, once they get them the different files, they'll know how to organize and differentiate them, um, either putting them where they have to go or evaluating them all to process your claim. They're very well versed in that.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, all right, perfect. And then another quick question, so I had called my, I don't know if you're the right person to speak to about this, but I did call, um, I had a bunch of procedures done with one of the doctors, and those are the claims that I'm trying to get processed or just uploaded and I had called over to the office because I noticed that I got a statement from them but they did not include um my APL.
[CUSTOMER][NEUTRAL] Um, when they were doing all, um, all the statements and claims and everything, so she had just called me back and said that uh it might not be covered because it's not technically um outpatient, which I thought it would have been, um, so now I'm kind of confused as to like what what I mean it's a huge.
[CUSTOMER][NEUTRAL] Uh, bill at the end of the day, so, and I thought, you know, having APL I'd be able to get it like most of it covered, um, so now I'm just.
[AGENT][NEUTRAL] Yeah. Do you know what?
[CUSTOMER][NEUTRAL] Concerned about
[AGENT][NEUTRAL] Do you know what the date of service was for the procedure you had and I can look at the claim and see if it was approved or denied.
[CUSTOMER][NEUTRAL] Um, there were a lot of, you know what, I went in my APL account and they actually did not do at this specific office they did not, um, uh, do anything with my UPL or APL account.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that's why I just went and uploaded all of the claims through my.
[AGENT][NEUTRAL] Oh, that's what all of this is OK.
[CUSTOMER][NEUTRAL] Yes, yes, that's through my United, which is my primary um health insurance, and then I, you know, I, all I sent over was the um the papers that I get in the mail, the explanation of benefits, uh, so I sent those over, that's what I just uploaded.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so,
[AGENT][NEUTRAL] Yeah, so let me pull up your outpatient information and I can tell you exactly what type of facilities are covered under your outpatient, um, and they're, I mean it's pretty comprehensive but it's not like uh it's not.
[CUSTOMER][NEUTRAL] That's what I'm, I guess.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't
[AGENT][NEUTRAL] I don't know. I'll read it to you. Um, there's a lot of options as far as the outpatients go. So you are covered outpatient in a hospital emergency room in an urgent care facility in a or surgery in a hospital outpatient facility or freestanding outpatient surgery center for diagnostic testing in a hospital outpatient facility or an MRI facility, outpatient treatment for a mental or an emotional disorder in a hospital outpatient facility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In a physical therapy facility in an ambulance. You also have, um, in a rider on here that's optional um for independent lab facilities. So if they take labs and they have to send them out to a different facility to process them and then give them the results, you have coverage there as well. So you have a lot of different coverage options with your outpatient benefits. It might not cover you in a physician's office, um, but that's the only limitation I'm seeing.
[CUSTOMER][NEUTRAL] OK, and so my question is this I.
[CUSTOMER][NEUTRAL] Obviously, I did these procedures. There were, I think like 6 or 7 of them, and I had asked, you know, obviously, am I covered under insurance? And they said yes, of course, and
[CUSTOMER][NEGATIVE] And now I come to find out that, you know, obviously I paid my co-pay when I went, but you know, my balance is um it's like $3000 so, um.
[CUSTOMER][NEGATIVE] And now they're telling me that it's not considered outpatient because it was done in the person in the doctor's office.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So, but it was like a medical procedure. That's why I thought it would still be, you know, it's not like I was getting, um, you know, blood work or whatever. It was like an actual like vein procedure. So I would, I would think that that would have been considered outpatient. Um.
[CUSTOMER][NEUTRAL] Cause it was an actual medical procedure.
[AGENT][NEUTRAL] Done so it's all gonna come back on how they code it so on their on the claim forms what they put as their location setting um but unfortunately I don't process claims so.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I might not be able to tell you like exactly what codes are what on a claim form, but I know when we're processing claims it's really gonna be the big, the big indicators for us are your major medical, um, because we follow them first and foremost, um, the diagnosis code, the procedure code, and the location, um, code, and like those are the big indicators for how we process something. So and until an examiner gets in to look at it like I wish I just knew the answer and I could give you all the information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, but I, it's sometimes you will go to a doctor and they'll code it as a clinic, and sometimes you'll go to a clinic and they'll code it as a doctor, and I wish I knew the nuances, but I'm not exactly certain. Um, I do know that you have, as far as your outpatient coverage goes, a lot of places where you are covered. So I just highly recommend submitting um a claim and letting it go from there.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right then I do you know approximately how long it takes like when, what should I do a follow up or.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, so for these, um, and make sure you sign up on your online service center to get texts because they'll text you as soon as it's done, but, um, on these ones, um.
[CUSTOMER][NEUTRAL] Oh, OK, OK, I'll do that.
[AGENT][NEUTRAL] It's typically 7 to 10 business days. Sometimes it's 2 or 3 business days, um, and sometimes it's the full 7 to 10, uh, but it's not a long grueling process and if they need more information, it might be just be um open minded if you ever get a denial sometimes it's denied pending more information but it's not like a final denial so just read those notes when they send them to you because sometimes they might just need some follow up or further information um to continue processing the claim, OK?
[AGENT][NEUTRAL] I know some people will see the denials and they'll get like, you know, their heart drops and it just always read more because sometimes it's just a request for more information.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] OK, alright, yeah, and then um OK so then I'll just keep checking um the website and then I'll just um.
[CUSTOMER][NEUTRAL] Get the I'll make sure I get text updates too.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And then 7 to 10 days.
[CUSTOMER][NEUTRAL] OK, and that I could do right online?
[AGENT][NEUTRAL] Yes absolutely I think it's under like my account when you go in there and there should be something for like communications.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] Communication preferences and then if you don't hear anything back like you can always give us a call if it's been a week or so and you're like oh I haven't heard anything I don't see anything online just give us a call um and we'll do our best to take care of you.
[CUSTOMER][POSITIVE] OK all right perfect.
[AGENT][NEUTRAL] All right. And then Miss [PII], is there anything else I can do to take care of you today?
[CUSTOMER][POSITIVE] Um, no, that was it for now. Thank you.
[AGENT][POSITIVE] It's my pleasure. If you need help along the way, give us a call. We're always here for you.
[CUSTOMER][POSITIVE] All right, thanks so much.
[AGENT][POSITIVE] My pleasure. You take care.
[CUSTOMER][NEUTRAL] Alright you too bye.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Bye.